Medication Tapering Is Associated with Increased Flare Risk in Patients with RA in Remission

At the American College of Rheumatology (ACR) Convergence 2021, researchers presented results from RHEUMTAP, a two-year prospective study of medication tapering in patients with rheumatoid arthritis (RA) in sustained remission.

The RHEUMTAP (Rheumatoid Arthritis Medication Tapering) study enrolled patients in sustained remission after treatment with biologics. Patients were treated at the Allegheny Health Network Rheumatology center between 2018 and 2020, with at least six months of follow-up. Remission was defined as Clinical Disease Activity Index (CDA) scores of <2.8, stable RA medication use, and absence of flares for at least six months. Tapering was defined as a reduction in biologic and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) dose or frequency, or treatment discontinuation.

Of 346 total patients, 131 had confirmed sustained remission, and 54 patients underwent medication tapering. Characteristics were similar between patients with or without tapering.

The overall incidence of RA flares during follow-up was 15% (n=20), of which 16 occurred in the taper group and four occurred in the non-taper group.

The biologics most frequently tapered were etanercept and adalimumab, and the csDMARD most frequently tapered was methotrexate. In the overall tapering group, flares were 7.6 times more common compared with patients who did not taper their medication (odds ratio [OR]=7.68, 95% confidence interval [CI] 2.4-24, P=0.0006). Patients tapering both a biologic and a csDMARD had amarkedly greater likelihood of flare (OR=26.93, 95% CI 2.5- 276, P <0.048) and shorter time to flare (hazard ratio=10.89, P=0.008) compared with patients in the no-taper group.

The authors summarized, “in our cohort, patients who tapered both biologics and csDMARDs were more likely to experience a flare and have a shorter time to flare. Larger studies are required to confirm our findings given our wide confidence intervals.”

Source: Tageldin M, et al. A Real-World 2-Year Prospective Study of Medication Tapering in Patients with RA in Sustained Remission in the RHEUmatoid Arthritis Medication TAPering (RHEUMTAP) Cohort. Arthritis Rheumatol. 2021;73(suppl 10). Presented at ACR Convergence 2021 (Virtual), Nov. 5-9, 2021.